Yes, I’m back after a month of adventures, and not just back, but I’m a woman on a mission — a matter of life and death.

It’s February, month of Valentines and hearts, and here’s a quick pop quiz for you: what are the typical symptoms of a heart attack?

I hear you — Pain in the chest. Pressure in the chest. Severe indigestion. Sorry, you only get 50% for your answer, because those symptoms are typical of heart attacks — in men. Symptoms of heart attacks in women are mostly different.

Having survived a wake-up call that was perilously close to the Last Trump, I want to make sure that everyone knows: in matters of the heart — like heart attacks and such — men and women are not the same. Their symptoms are different, the numbers are different, the diagnostics are different.

I was doubtful about boring those of you who are a) not women, and b) not so old as to think it might affect you. And then I realized that every person reading this right now has a mother, wife, sister, daughter, granddaughter, aunt, grandmother, female cousin, female friend — After all, women are half of the human race, and we’re all connected. Therefore matters of the heart matter to everyone. Even though this post is long, the information in it can be a matter of life or death to someone in your life, so I hope you’ll make time to read it all the way through.

Second half of pop quiz. What are typical symptoms of heart attacks in women? Are you ready for these answers:

Pain in the arms. Pain in the back. Pain in the shoulders. Pain in the jaw. And fatigue.

Pain in the chest is conspicuous by its absence. Surprised? I was, when it happened to me.

I learned all this the hard way. The evening of January 4th, typing away at the computer, I was suddenly gripped (pun intended) by such intense pain in both upper arms I nearly passed out in my chair. I gasped to my husband, Call 911, and then the pain took over.

Within minutes the Northampton EMT’s were there from the firehouse. Just like on TV, exuding so much calm, competence, and confidence that I felt better just for their presence. Within four minutes I was in the local hospital emergency room. And then we waited. And waited. And waited. Finally I ended up being admitted to a room at four in the morning, with a tentative diagnosis of atypical heart attack. (Atypical: pain in the arms, not the chest). Two EKG’s, however, were normal. A test for elevated enzymes (you’ll have to Google it yourself), one during the night and one the next day, were both normal. Treadmill stress test — also normal. So I went home that afternoon without a firm diagnosis.

(A gloomy cardiologist who saw me before I was released warned that a simple treadmill stress test wasn’t sufficient to rule out heart disease in women: the nuclear stress test is the gold standard, he said. But I had all these normal numbers, so why borrow trouble? was my thought.)

Back home, a day and a half went by and then the arm pains returned. I began Googling Repetitive Stress Injury. (I spend a LOT of time on the computer.) Sure enough, symptoms of RSI are unpredictable episodes of intense pain. I saw my primary physician, who went over my hospital test results, and we both said, heart? Nah. Unlikely. All the numbers on all the diagnostic tests are normal! So I began physical therapy for a stress injury.

But nothing seemed to have any effect on those severe and unpredictable pains. Episodes kept coming, up to a dozen a day; at night it was impossible to lie down and sleep. I migrated with afghan and pillow to the sofa, but still couldn’t sleep. At last, ground down by pain, I went to the doctor again and said, I’m ready, I’ll take a nuclear stress test, anything to at least clear away that little bit of anxiety about it being the heart —

So we scheduled the nuclear stress test, and you can probably write the story from here yourselves. To my astonishment and dismay, I flunked. When I resisted the suggestion of cardiac catheterization to determine precisely what was going on (I’m good at resistance), the technician excused herself and came back with the interventional cardiologist (did you ever hear of such a thing? now you have) who simply sat there, an immovable force. I am concerned, he said. There is something wrong, he said. This must be done, he said. Tomorrow morning.

It turned out, you see, that I had a 95% blockage of the left anterior descending artery of my heart. To make that geography more understandable I’ll just pass on what my physician told me later: “In men we call that the Widow-maker.” With the placement of the stent, blood began flowing freely again through the artery and the pain (which turned out to be angina pain, not repetitive stress injury) was gone.

And now, the moral of this Valentine’s story: with “normal” numbers on enzymes, on EKG’s, on treadmill stress tests —this woman’s damaged heart didn’t register a problem. Nor did the arm pains. After all, they weren’t chest pains, right? Wrong.

Because when it comes to matters of the heart, in current medical practice normal is still male normal, not female normal! If you remember nothing else, remember this:

Pain in arms, jaw, back or shoulders, and fatigue are typical signs of heart attack in women.

Diagnostics may be definitive for men, but they are not definitive for women: a nuclear stress test is the gold standard.

So there’s my Valentine’s message to you, offered with a full and grateful heart, for the heart safety of all women of your acquaintance. Remember it, and pass it on!

(And my very special thanks and gratitude to everyone who left comments or sent emails of good wishes over the past weeks. You can’t know how much light and warmth you radiated in a dark time for me.)

So happy to see you back! Many people say that they get a new lease on life after the placement of a stent. I knew this stuff already, partly because of the job I had in cardiology for a few years, and for other, more «close to the heart»-reasons. I never go anywhere without nitro and another little pill I have.

But these are important, little-known-of symptoms …people only seem to know about the male symptoms. Very well written.

Well, I’m waiting for the new lease on life — but I’ll have faith, Rebekah! I too now have nitro pills, although I haven’t yet taken one. But I feel better just knowing they’re there. Look at all this little-known stuff about well-known genders! How long will it be before women are defined for and by themselves?????
I’m happy to be back, and I’m very happy to see you back here on wordpress, where it’s easy to continue the conversation!

Judith, I am happy to see you back, and DELIGHTED to see you back HEALTHY! The exact same scenario happened to my MIL (almost word-for-word) – so yes, spreading the word about heart symptoms in WOMEN is critical. What a timely post, with the 14th approaching and all. 🙂 Welcome back, healthy lady!

Thank you, Stef. It feels good to be back in the blogosphere.
It’s going to turn out that many individuals are educated (one way or another!) about this — but it still hasn’t penetrated the public sphere, where it needs to be. What shall we call our efforts? The Valentine Initiative??????

This is the the best and most heartfelt (pun intended) valentine I’ve every received. I’ll be sharing your story with those near and dear to my heart (yeah, another one). It’s disheartening (I can’t stop with the wordplay) that a continued gender gap in the study of life sciences can have life threatening repercussions. I am heartened (I swear, this is my last one!) that this is changing because there are more women entering the health field with a practitioner/scientist focus.

Wanted to add that in my, native Sweden … when the concept of St. Valentine’s Day was adopted [some time in the late 60’s], the day didn’t get the name Valentine’s. Instead it’s called ‘All Hearts’ Day’ [but in Swedish, of course]. Little by little, this day has turned into The Heart & Stroke Foundation’s day, secondary to the ordinary Valentine’s stuff…

They put out lots of heart related info on that day …also in a ‘funny or cute’ sort of way, that might be easier to digest..

That’s interesting, Rebekah — and sounds like an effective way to get information out there. I like the name All Hearts’ Day very much also —
Wonder if the American Heart Association could benefit from this? Or whoever does the best job of informing the public —

Whew. That was a close one! I’m so pleased to read that you acted quickly and were persistent about getting to the “heart” of the matter! Wondering if any of your specialists recommended keeping aspirin by your bedside. The Mayo recommends chewing and swallowing an adult aspirin, unless you’re allergic to aspirin or have been told by your doctor never to take aspirin AFTER calling 911, which will help thin the blood and buy crucial time.

When we called 911, they suggested taking an aspirin. Or maybe the EMT’s gave me one and had me chew it — that was back at the beginning of January, and I’m a bit hazy. But now part of my regime is a baby aspirin every day. (It’s now called “low dose aspirin”, for the image, no doubt!)

I was delighted to see your new posts arrive today – and even more so to hear the strength of your voice and conviction. Thank you for sharing your story with all of us, and for encouraging us to pass it on to others. A true friend and teacher.

Reblogged this on Changeversations and commented:
Thanks for sharing your experiences with us. I want to help spread the “matter of life and death” message by re-blogging your post. I’m glad you’re feeling better and have decided to take on this worthy mission thru blogging. Many happy and healthy years to you!!

SO glad you’re up and about and posting again. Will share your post with ALL my female friends and relatives. Add me to the list of women who did not know the signs were so different. A good many men in my family died of heart attacks so I’ll be extra conscious now that any symptoms I have will not necessarily mimic theirs! I like All Hearts Day, too – you ought to send this post to the Heart Association and see what comes of it.

Reblogged this on absence of snow and commented:
For quite some time now, I’ve been worrying about a fellow blogger. Funny, but also wonderful, how we become connected to people we’ve never met and most likely will never meet, in real life. This morning, I had this post in my inbox. Not only was it very relieving to hear from my friend, but it was also filled with important information. I myself, already knew about this thanks to my job …I worked a couple of years in cardiology [admin], and also due to massive heredity for heart disease.

Hi,
I arrived here from Rebekah blog “absence of snow” and I am amazed with the run around you got, why is it that in this day and age they still can’t diagnose what is happening to women?
I would like to Thank You for sharing your story and the information as well.

Hi Judith, I was wondering where you were, and I have arrived here from Rebekah’s blog; I’m so glad she re-blogged yours. Amazing how we are all connected!
I’m shocked to hear what has been happening to you, and the information you provide here is priceless – I had no idea heart attack symptoms are different for women, so thank you so much for the warning. I will be passing this on to many, so they can be fully informed.
Glad to see you back – in more ways than one! Take care.

To me, this month was the the demonstration of a modern medical miracle. But the pity of it all has been that the cardio-symtomatic differences in men and women have never been fully recognized by the medical profession. How can this be. Women do not get heart attacks as readily as men for the very reason that their signals are different. And so, they sicken and perhaps die of natural causes whatever that means. The means to treat female symptoms are readily available. You proved that well, Judy. A wonderful recovery and continued good health from Frank —

Hi Judith, A good story with a happy ending. Thanks for sharing it. I was wondering about your cyber-silence. There’s an old saying, “Diseases don’t read textbooks.” Your story underscores it. Have a great Valentine’s Day. Best, David

Arriving here from Rebekah’s blog…thank you for the posting this information. I am glad you are better.
I, too, had an atypical heart attack in 2006; I had been in and out of the hospital with nausea and sent home more often than not; the last time, a female Indian doctor insisted I stay overnight and the next day I had the cardiac catheterization. Was lucky and did not have to have a stent; blockage is watched and I feel better knowing that the doctors are aware of my problem….nausea and breaking out in a cold sweat are also symptoms in some females.

Yes, nausea and cold sweat are more, and breathlessness. (Some things are shared with men, but the location of the pain seems to be gender specific!)
Thanks for your comment, Linda. And glad about your own happy ending — and that you had a persistent/insistent physician —

Hi Judith,
I am truly happy you are back to blog and discuss. I was shocked by your story in more than just one way. And I am very grateful you shared it: As you say, there actually are a couple of women around who are, well, close to my heart.
I am looking forward to new, exciting discussions.
Best wishes, Tobias

Incidentally, the time of pain and wondering without a diagnosis was bad — and I wanted to tell you that Martin Walker and chief of police Bruno brightened several sleepless nights! Vielen dank — I’m continuing reading the series.

Your story has really made me stop in my tracks and think. What a frightening experience for you (and your husband) – that was a pretty close shave I’d say. And how useful this information in your post. It is shocking to realise how little most of us know about how heart attacks present in women.
I’m so glad your story had a happy outcome and that you are okay. Welcome back and thank you for putting this post out there.

Yes, it’s often harder for the one who has to watch — and it was tough on Frank. Until this week I didn’t realize just HOW close it had been — because I did actually have a heart attack. There’s still a lot of unreality about saying that, which distances it.
It’s good to be back, and thank you for the welcome, Karen! Get that info passed around —-

My symptoms (arm pain) were the same in 1991 … My very able internist insisted on a stress test. It was positive for a blockage but the attending cardiologist said it was a “false” positive as I was too young (49) and the wrong sex! Able internist demanded a nuclear stress test, resulting in locating a 95% blockage in the left anterior – same as you.

You say you did have a heart attack (myocardial infarction), and if so, how was that determined? Although I had significant angina attacks, I never had a heart attack with subsequent damage to heart tissue.

I’m seeing the cardiologist on Monday for the first time since the catheterization and stent. So I’ll know more about when the heart attack occurred — at the first instance, or sometime during the numerous angina episodes following. At least I guess I’ll know more! As far as damage — he’s scheduled an echocardiogram for two months from now. Meanwhile I expect to be starting cardiac rehab exercise next week. So we shall see — the drama unfolds. There’s a lot of unreality about it! BTW my treadmill stress test did not indicate any blockage — only on the nuclear stress test a few weeks later.

So VERY VERY glad to see you back Judy!! –
I’d thought you just needed a break from the demands of being a 24×7 blogger – as I often need from being a blog 24×7 surfer 🙂 ! – so when I looked in on you a week back after a long time away from the internets, I wasn’t surprised to hear that you were “away” for a while.
SO stunned to hear it was not for some R&R nor RSI or any other pleasant or less pleasant escapes – but a full blown EVENT!
I left you a quick email yesterday and hope that you are taking full post-op care. And as I noted your detailed documentation of your experience is one huge public service!
Anyway you now know that you can’t leave the party – its too early!!!
And you have a mission! Tending this little garden – it was such a treat to browse through all the stories I’d missed! The one on praying was beautiful! You have such a unique talent – crafting words and thoughts with the lightest of ‘touches’, if I may use that word 😉 and stringing up stories of whole other worlds and ideas! So we love you and your blog – can’t let you go now 🙂

Oh my gracious, you have been through quite the trial. I am so happy to see you are back. I look forward to hearing more of your recovery. Thanks, Judith, for the education you have provided us in this post.

So glad you are doing well. Listening to our bodies is an important direction for women.
Matters of the heart is direct and wonderfully stated to all women. We are different than
men and we celebrate the differences, and matters of the heart is inspiring for all of us! Thank you Judy

I am in a state of shock! I had no idea you were going through all of this Judy. I am just sorry I couldn’t have been a part of the cheering and special praying team although you and Frank are never far from my mind and prayers. I am happy the news that I do hear at this point is that you are on the mend and being monitored. The news just enhances the gratitude I feel for you my dear friend. Be well, continued good health. You and Frank are my Valentines
x0x0 Love Therese

Oh, it was a time, Therese! Glad it’s behind me, and grateful for the absolute miracles of modern science. What they can do now, it used to be the subject of science fiction movies, like Incredible Voyage!

The heart aches in happiness, too. Welcome back, my dear inspiring friend. I’m glad you’re feeling better. And I’m so grateful for matters of the heart, for sharing your story. There’s a woman out there that this story will save. Blessings, Susan

Judith,
I have rushed through the reading of this, not because I am busy, with lack of time etc, but out of disbelief at your condition – the 95% blockage stood out! So relieved for you that treatment and management have pulled you through the danger zone. Wishing you good health and thank you so much for letting us know.

Oh goodness! Thank you for sharing this story. And so relieved that you’re ok. This was very well written and gave me info that I’d not heard before. Welcome back and I too wish you continued good health.